In summary, the results of this study suggest that clinicians should be aware of the potential for severe scrub typhus, when scrub typhus patients are older (≥ 60 years), present with the absence of eschar, or laboratory findings such as WBC counts > 10, 000/mm3, and serum albumin level ≤ 3.0 g/dL. The gene discussed is ALB; the disease is scrub typhus.